A New Model for Dealing with Patients Who Frequently Arrive
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Persson L et al., Int J Nurs Clin Pract 2014, 1: 103 http://dx.doi.org/10.15344/2394-4978/2014/103 International Journal of Nursing & Clinical Practices Research Article Open Access A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study Lena Persson*, Ingela Furenback and Liselotte Jakobsson School of Health and Society, Kristianstad University, Elmetorpsvagen 15, 29188 Kristianstad, Sweden Abstract Publication History: Received: September 08, 2014 Background: Patients who repeatedly seek care directly at hospital based somatic emergency Accepted: November 17, 2014 departments take up a large proportion of health care resources, at the same time they appear to Published: November 19, 2014 experience low satisfaction with the care they receive. The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to a somatic hospital based ED; II) Eventual changes, over six months, in costs and patients’ health care utilization related to pilot testing Keywords: the model and III), the team’s experiences of implementing the model. Emergency nursing, Frequent Methods: A mixed method convergent parallel design was used. visitors, Interprofessional Results: The development of the model began as a top-down process and later on into a bottom-up collaboration, Team-based practice approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 73 visits (55%). Conclusion: The inference quality description is that a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. Increased communication between different professionals within the hospital and between different caregivers such as ED, primary health care and community social- and health-care, increases the possibility for the patients to be cared for in a sustainable and non-fragmented way. Background identified elsewhere are those with chronically severe medical There is an ongoing debate in the community in Western countries problems, [13], or mental and behavioural disorders [14], or suffer about what is the right use of hospital emergency departments (ED) from co-morbidity related to somatic concerns, psychiatric illness and how to best take care of the needs of an increasing proportion and substance abuse [15]. These patients engage a large proportion of of the population who use them. People who repeatedly seek care health care resources while at the same time they appear to experience through ED are engaging a large portion of health care resources and less satisfaction with the health care system than other patient groups experience greater dissatisfaction with health care than other patient [2,3]. These circumstances create frustration among the staff as well as groups. This creates frustration for the staff within the health care and increased suffering for the patients [1]. The findings have resulted in involves suffering for the patient. These patients often present multiple an ongoing debate among health care providers concerning both the diseases with high grad of mental illness [1-3]. In order to offer an objectives of somatic hospital based ED and how to provide the best effective and safe treatment in which care is provided at the right practice when taking care of patients who frequently visit a hospital level and to avoid repeated visits to the ED a good communication based ED [1,16,17]. Some beneficial results have been found in and close collaboration is needed between the hospital specialist studies covering the effectiveness of case management (CM). Kumar care, primary care, community care and informal care [1,4]. General & Klein [18] showed, in their literature review, that intensive CM research evidence are lacking for how these people should be taken reduced the cost and number of ED visits. The content of such a care of in an optimal way. Some studies, though, show a need for CM programme involved frequent follow-up of patients, availability continuity and collaboration between health care providers to avoid of psychosocial services and finance entitlements plus a high level of deficiencies in the quality and high total cost of care [1-4]. Reasonably patient involvement in care planning. Although the literature review this is applicable to various ED care, however little described for presented beneficial outcomes in providing intensive CM at somatic frequent visitors to an ED department. hospital based ED, the authors concluded that there was a need for further studies covering how best to take care of frequent visitors The objective of somatic hospital based ED is to provide highly to ED. This is a conclusion which is supported by other researchers professional care to patients who are in need of urgent or emergency [8,19-21]. In Sweden and, to our knowledge, no intervention study somatic care at any time of the day. The care provided has to be based on evidence based medical practice as well as on individually *Corresponding Author: Lena Persson, School of Health and Society, based nursing [5,6]. However, during the last decades the function Kristianstad University, Elmetorpsvagen 15, 29188 Kristianstad, Sweden; E-mail: of somatic hospital based ED has gradually changed, mainly due to [email protected] the characteristics of today’s patients visiting ED. For example, studies from Western countries point out that patients nowadays’ more often Citation: Persson L, Furenback I, Jakobsson L (2014) A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency use somatic hospital based ED for reasons that are beyond somatic Departments Requiring Health Care: A Pilot Study. Int J Nurs Clin Pract 1: 103. concerns and are in fact based on psychological and social reasons doi: http://dx.doi.org/10.15344/2394-4978/2014/103 [3,7,8]. Prior studies has shown that ED frequent visitors are a Copyright: © 2014 Persson et al. This is an open-access article distributed psychosocial vulnerable group with poor mental health, low level of under the terms of the Creative Commons Attribution License, which permits perceived social support and heavy users of general practitioners and unrestricted use, distribution, and reproduction in any medium, provided the other primary care forms [9-12]. Further groups of frequent visitors original author and source are credited. Int J Nurs Clin Pract IJNCP, an open access journal ISSN: 2394-4978 Volume 1. 2014. 103 Citation: Persson L, Furenback I, Jakobsson L (2014) A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study. Int J Nurs Clin Pract 1: 103. doi: http://dx.doi.org/10.15344/2394-4978/2014/103 Page 2 of 6 covering models for reducing costs and frequent visits at ED has triage nurse and patients with self-injurious behavior. The reason for been published. The purpose of this study was to describe: I) the their exclusion was that they were already included in the system and development of a team model for taking care of frequent visitors in a that they would perhaps profit from ED care. somatic hospital based ED; II) eventual changes after six months in costs and patients’ health care utilization related to pilot testing and During the 3 month period March to May 2012 patients were III) the team’s working experience of the model. included consecutively. In total, 180 people sought care at the hospital ED and met a physician, more than four times counted from January Methods 2012. Of these, 92 patients met the inclusion criteria, however, only 25 were asked to participate in this study, 12 accepted, three declined and This study was performed using a convergent parallel mixed method 10 patients wished to be contacted later. The remaining 67 patients, approach [22] involving the collection and analysis of quantitative who met the inclusion criteria, were not invited to participate for and qualitative data. various reasons. The most common reasons where the emergency nurse’s shortage of time (n=40) as she was the key person in the team, Quantitative data concerning patients´ characteristics were collected then patients with separate diagnosis (e.g. gallstones or kidney stone) with regard to their gender, age, housing situation, social, work and (n=22) and other causes (n=5). economic situation. Also information regarding who had initiated the patient’s contact with ED, the method of their transportation to ED, When the patient was admitted to the ED, the emergency nurse any previous support from the municipality and whether or not a contacted them to ask for their informed consent to partake in the previously planned care appointment had been fulfilled. study. Patients who already were discharged were contacted by phone. For collecting data about the patients a standardized questionnaire To identify changes in patients’ search patterns from the ED data was applied, with questions complementing patients’ records and were collected from the hospital. The data consisted of patient records the assessment of patients’ status. The Prime MD (Primary care and statistics about patients’ health care utilization. Data, such as the evaluation of mental disorders) was used to evaluate mood, anxiety, number of visits, was compared from six months prior to the patient’s somatoform, and alcohol and eating disorders [25,26] The form was inclusion in the study to six months after. An economic evaluation further complemented with four questions regarding physical and was conducted using the hospital's standardized cost calculation for a psychological abuse. patient visit to the ED. To evaluate the staff’s experience of the model qualitative interviews Qualitative data was collected by interviewing staff included in were conducted [27], either individually or in groups, focusing the Executive inter-professional team and the project manager, on their own experience.